The role of endovascular therapy is expanding in the treatment of acute limb ischemia (ALI). In addition to catheter-based thrombolysis, there are multiple devices which allow for clot disruption and aspiration. The Trellis catheter system provides mechanical agitation of thrombus coupled with chemical thrombolysis. We present two cases of native arterial occlusions in which the Trellis catheter was used for thrombolysis. Procedural tips and challenges associated with the use of this device in native vessels are discussed. © 2012 Wiley Periodicals, Inc.